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Interferon-gamma in 388 immunocompromised and immunocompetent patients for diagnosing pleural tuberculosis
V Villena1, A López-Encuentra, J Echave-Sustaeta
1Respiratory dept, Hospital Universitario 12 de Octubre, Madrid, Spain.
Insights
Interferon-gamma (IFN-gamma) in pleural fluid is a highly accurate marker for diagnosing tuberculous pleurisy. This diagnostic value holds true even for immunocompromised patients, including those with HIV.
Area of Science:
- Immunology
- Infectious Diseases
- Pulmonology
Background:
- Elevated pleural fluid interferon-gamma (IFN-gamma) suggests tuberculosis, but its diagnostic utility, especially in immunocompromised individuals, requires further validation.
- Previous studies have not comprehensively evaluated IFN-gamma's role in diagnosing tuberculous pleurisy among immunocompromised patient populations.
Purpose of the Study:
- To assess the diagnostic value of pleural fluid IFN-gamma levels for tuberculous pleurisy in both immunocompetent and immunocompromised patients.
- To establish the reliability of IFN-gamma as a biomarker across diverse patient groups, including those with HIV.
Main Methods:
- Prospective study of 388 patients with pleural effusions (73 tuberculous, 315 non-tuberculous).
- Interferon-gamma (IFN-gamma) levels measured using radioimmunoassay.
- Analysis included immunocompromised patients (HIV-positive, post-liver transplant) and those with other conditions like lymphoma and vasculitis.
Main Results:
- High diagnostic accuracy for IFN-gamma in pleural fluid: sensitivity of 0.99 (95% CI 0.93-1.00) and specificity of 0.98 (95% CI 0.96-1.00) at a 3.7 U/mL cut-off.
- Diagnostic performance of IFN-gamma remained consistent between HIV-positive and HIV-negative patients.
- Abnormal IFN-gamma levels were not observed in patients with lymphoma, vasculitis, or vascular connective tissue disease.
Conclusions:
- Pleural fluid interferon-gamma (IFN-gamma) is a highly effective diagnostic marker for tuberculous pleural effusion.
- The diagnostic accuracy of IFN-gamma is maintained even in immunocompromised patient cohorts, including those with HIV infection.
Abstract:
The level of interferon-gamma (IFN-gamma) in pleural fluid has been reported to be increased in pleural tuberculosis. Nevertheless, its diagnostic value has not yet been well-established, and immunocompromised patients have not previously been evaluated. The aim of this study was to determine the value of the IFN-gamma level in pleural fluid for diagnosing tuberculous pleurisy in immunocompetent and immunocompromised patients. Three hundred and eighty eight consecutive patients were studied prospectively (73 with tuberculous pleural effusions, including nine with concurrent human immunodeficiency virus (HIV) infection and one after liver transplantation, and 315 with nontuberculous effusions). IFN-gamma was measured by radioimmunoassay. The sensitivity of the test, using a 3.7 U.mL-1 cut-off point, was 0.99 (95% confidence interval (95% CI) 0.93-1.00) and the specificity was 0.98 (95% CI 0.96-1.00). The sensitivity of the test did not differ in HIV-positive and HIV-negative patients. Patients with lymphoma, vasculitis or vascular connective tissue disease did not have abnormal IFN-gamma values. In conclusion, the level of interferon-gamma in pleural fluid is a very good diagnostic marker of tuberculous pleural effusion, even in immunocompromised patients.